Matsuo N, Yokoyama K, Maruyama Y, Ueda Y, Yoshida H, Tanno Y, Yamamoto R, Terawaki H, Ikeda M, Hanaoka K, Yamamoto H, Ogura M, Watanabe S, Kimura Y, Hosoya T
Division of Kidney and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
Clin Nephrol. 2010 Sep;74(3):209-16. doi: 10.5414/cnp74209.
Although peritoneal dialysis (PD) is recommended as the first-line treatment for end-stage renal disease, limitations exist to achieving good clinical status when the residual renal function (RRF) has declined. Combined therapy with PD and hemodialysis (HD) is the treatment of choice for patients who cannot control body fluid status and/or cannot obtain adequate solute removal by PD alone. The aim of this study was to evaluate the clinical efficacy of this combined therapy.
In this retrospective study, 53 patients on PD and diagnosed with underdialysis and/or overhydration with declining RRF were recruited. Parameters of volume control, uremic solute removal, anemia, and predictors for encapsulating peritoneal sclerosis (EPS) were compared before and 1 year after combined therapy.
The patients' hydration status improved significantly with reductions in atrial natriuretic peptide and blood pressure. Serum creatinine and beta2 microglobulin also decreased significantly. The hemoglobin level increased remarkably from 8.2 ± 1.6 to 10.7 ± 1.2 g/dl (p < 0.01) and the reticulocyte count also increased significantly, even though at the same time the dose of recombinant human erythropoietin decreased significantly. The dialysate to plasma creatinine ratio obtained from the fast peritoneal equilibration test (PET) decreased significantly from 0.65 ± 0.11 to 0.59 ± 0.13, and the level of interleukin 6 in PET drainage also significantly decreased. Furthermore, serum C-reactive protein and fibrinogen decreased significantly.
Combined therapy with PD and HD is an effective way to control fluid status and to correct inadequate solute removal, leading to improvement in inflammation, peritoneal function and anemia.
尽管腹膜透析（PD）被推荐作为终末期肾病的一线治疗方法，但当残余肾功能（RRF）下降时，要达到良好的临床状态仍存在局限性。对于无法控制体液状态和/或仅通过PD无法充分清除溶质的患者，PD与血液透析（HD）联合治疗是首选的治疗方法。本研究的目的是评估这种联合治疗的临床疗效。
在这项回顾性研究中，招募了53例接受PD治疗且诊断为透析不足和/或水过多且RRF下降的患者。比较联合治疗前和治疗1年后的容量控制、尿毒症溶质清除、贫血参数以及包裹性腹膜硬化（EPS）的预测指标。
患者的水合状态显著改善，心房利钠肽和血压降低。血清肌酐和β2微球蛋白也显著下降。血红蛋白水平从8.2±1.6显著升至10.7±1.2 g/dl（p<0.01），网织红细胞计数也显著增加，尽管同时重组人促红细胞生成素的剂量显著降低。快速腹膜平衡试验（PET）得到的透析液与血浆肌酐比值从0.65±0.11显著降至0.59±0.13，PET引流液中的白细胞介素6水平也显著降低。此外，血清C反应蛋白和纤维蛋白原显著下降。
PD与HD联合治疗是控制体液状态和纠正溶质清除不足的有效方法，可改善炎症、腹膜功能和贫血。
